Medical
Student Section Legislative Update
The
First Session of 110th Congress has been very active. The House
has passed a number of bills related to student debt and the cost of higher
education – and the Senate is actively pursuing similar legislation.
The Higher Education Act (HEA), which was set to expire at the end of
June, was recently extended by the House to the end of October, but is
awaiting passage in the Senate. Regarding the uninsured, SCHIP reauthorization
bills continue to be debated in both houses of Congress. The House of
Representatives is also active on residency and physician workforce issues,
such as Graduate Medical Education funding and incentives for high-need
specialties. Both the House and the Senate are working to craft a solution
to the Sustainable Growth Rate (SGR) problem, which is the concern over
Medicare, TRICARE, Medicaid and private physician reimbursement rates
that continues to plague physicians and has implications for access to
care far into the future. Health Information Technology (HIT) has broad
implications and continues to be an issue around which there is a lot
of activity. Likewise, the Prescription Drug User Fee Act (PDUFA) is up
for renewal this year and is currently being debated – as are various
pieces of legislation related to patient safety. Finally, stem cell research
legislation has again been presented to the President, but is awaiting
final action – a veto is expected.
MSS
Committee on Legislation and Advocacy Resources
AMA
Grassroots Action Center
AMA
Advocacy Activity, AMA
Agenda
AMA
Political Education
******The
AMA is not responsible for any content or links on this page.******
List
of issues: you may click on the title of the legislation to see a blurb
about that particular legislation, if available, or about the issue:
·
HEA
and Student
Debt
·
SCHIP
and Access to Care
·
Physician
Workforce
·
Physician
Reimbursement and SGR
·
Health
Information Technology
·
Patient
Safety and Prescription Drugs
·
Stem
Cell Research
|
Higher
Education Act (HEA)
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Number
and Title of Legislation
|
Last
Action
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AMA Recommendations
for HEA Reauthorization
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HR
2559 – First Higher Education Extension Act of 2007
|
House
– Passed on June 6, 2007.
Senate
– Referred to the Committee on Health, Education, Labor, and
Pensions on June 7, 2007.
|
|
HR
2690 – College Affordability and Accountability Act
|
House
– Referred to the Committee on Education and Labor on June
12, 2007.
|
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HR 2669 –
College Cost Reduction Act of 2007
|
House
– Marked up by the Committee on Education and Labor on June
13, 2007.
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|
Collection of Articles on the
HEA
Return
to the Top
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Student
Debt
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Number
and Title of Legislation
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Last
Action
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HR 890 – Student
Loan Sunshine Act
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House
– Passed on May 9, 2007.
Senate
– Referred to the HELP Committee on May 10, 2007.
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HR 2669 –
College Cost Reduction Act of 2007
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House
– Marked up by the Committee on Education and Labor on June
13, 2007.
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S 1066 –
Medical Education Affordability Act
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Senate
– Referred to the Committee on Health, Education, Labor, and
Pensions on March 29, 2007.
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|
HR
1994 – Financial Aid Accountability and Transparency Act of
2007
Return
to the Top
|
House
– Referred to the Committees on Education and Labor and on
Financial Services on April 23, 2007.
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SCHIP
and Access to Care
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Number
and Title of Legislation
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Last
Action
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AMA on SCHIP
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HR 2147 – Healthy
Kids Act of 2007
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House
– Referred to Committees on Energy and Commerce and on Ways
and Means on May 3, 2007.
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|
S
1224 – Children's Health Insurance Program (CHIP) Reauthorization
Act of 2007
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Senate
– Referred to the Committee on Finance on April 25, 2007.
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HR
2626 – Comprehensive Health Coverage and Reform Enhancement
Act of 2007
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House
– Referred to Committees on Ways and Means, House Energy and
Commerce, Education and Labor, Oversight and Government Reform and
the Judiciary on June 7, 2007.
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S 1019
– Universal Health Care Choice and Access Act
Return
to the Top
|
Senate
– Referred to the Committee on Finance on March 28, 2007.
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Physician
Workforce
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Number
and Title of Legislation
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Last
Action
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S
1576 – Minority Health Improvement and Health Disparity Elimination
Act
|
Senate
– Referred to the Committee on Health, Education, Labor, and
Pensions on June 7, 2007.
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S 1348
– Comprehensive Immigration Reform Act of 2007
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Senate
– Introduced May 9, 2007.
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HR
2583 – Physician Workforce and Graduate Medical Education
Enhancement Act of 2007
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House
– Referred to the Committee on Energy and Commerce on June
6, 2007.
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HR
2584 – High-Need Physician Workforce Incentives Act of 2007
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House
– Referred to the Committees on Energy and Commerce and on
Ways and Means on June 6, 2007.
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HR
2585 – Ensuring the Future Physician Workforce Act of 2007
Return
to the Top
|
House
– Referred to the Committee on Energy and Commerce and the
Committee on Ways and Means on June 6, 2007.
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Physician
Reimbursement and SGR
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Number
and Title of Legislation
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Last
Action
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AMA and the SGR
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HR
2585 – Ensuring the Future Physician Workforce Act of 2007
Return
to the Top
|
House
– Referred to the Committee on Energy and Commerce and the
Committee on Ways and Means on June 6, 2007.
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Health
Information Technology
|
|
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Number
and Title of Legislation
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Last
Action
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S 1408
– Health Information Technology Act of 2007
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Senate
– Referred to the Committee on Finance on May 16, 2007.
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S ____ –
Wired for Health Care Quality Act
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Yet
to be introduced.
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S
1455 – National Health Information Technology and Privacy
Advancement Act of 2007
|
Senate
– Referred to the Committee on Health, Education, Labor, and
Pensions on May 23, 2007.
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HR
1952 – National Health Information Incentive Act of 2007
|
House
– Referred to Committee on Energy and Commerce and to the
Committee on Ways and Means on April 19, 2007.
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HR 1467 –
10,000 Trained by 2010 Act
|
House
– Passed on June 6, 2007.
Senate
– Referred to the Committee on Health, Education, Labor, and
Pensions on June 7, 2007.
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HR ____
– Personalized Health Information Act of 2007
Return
to the Top
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Yet
to be introduced.
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Patient
Safety and Prescription Drugs
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|
Number
and Title of Legislation
|
Last
Action
|
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S
1082 – Prescription Drug User Fee Amendments of 2007
|
House
– Received May 10, 2007.
Senate
– Passed on May 9, 2007.
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HR
2260 – Healthcare Truth and Transparency Act of 2007
|
House
– Referred to the Committee on Energy and Commerce on May
10, 2007.
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HR 1038 –
Access to Life-Saving Medicine Act
|
House
– Referred to the Committees on Energy and Commerce and on
the Judiciary on February 14, 2007.
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HR
1956 – Patient Protection and Innovative Biologic Medicines
Act of 2007
|
House
– Referred to the Committee on Energy and Commerce on April
19, 2007.
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S 1505 –
Affordable Biologics for Consumers Act
Return
to the Top
|
Senate
– Referred to the Committee on Health, Education, Labor, and
Pensions on May 24, 2007.
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Stem
Cell Research
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Number
and Title of Legislation
|
Last
Action
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|
S
5 – Stem Cell Research Enhancement Act of 2007
Return
to the Top
|
House
– Passed on June 7, 2007.
Senate
– Passed on April 11, 2007.
|
AMA
Recommendations for House HEA Reauthorization
Student
debt relief is a high priority for the medical student, resident physician,
and young physician members of the American Medical Association (AMA).
As the Congress develops legislation to reauthorize the Higher Education
Act (HEA), the AMA offers the following recommendations:
1.
Ensure
Fair, Low Interest Rates for New Student Loans
The
average debt for medical school graduates in 2006 was $130,500.
Such debt is a tremendous hardship throughout the repayment period of
the loan, but it is especially difficult during the years in which a physician
is undergoing his or her three to seven years of training in a residency
program. The average starting salary of a resident physician is
$43,266 per year, and this figure does not substantially increase throughout
residency training.
Reauthorization
legislation should provide for fair, low interest rates for new student
loans to help medical students, residents, and young physicians better
manage their debt.
2.
Expand
the Definition of “Economic Hardship” for Loan Deferment
Under
current law, resident physicians may qualify for a three-year student
loan deferment period when qualifying under an “economic hardship.”
The primary factors for determining economic hardship are the borrower’s
income and his or her debt-to-income ratio. The AMA supports modifying
the definition of economic hardship so that all educational loans, including
school-certified private or alternative loans as well as institutional
loans, are included in the calculation for determining eligibility for
the economic hardship deferment. While these loans are not eligible
for the deferment, they do represent legitimate educational debt burden
and should be included in the debt-to-income calculation.
3.
Expand
the Loan Deferment Period
Graduation
from medical school is not the beginning of a medical career. Physicians-in-training
must still complete a residency training period. The length of a
residency depends on the physician’s specialty. For example,
residency programs typically last three years for primary care, family
medicine and pediatrics; four years for obstetrics/gynecology; and up
to seven years for surgery and other subspecialties.
Because
of their high debt-to-income ratio, many physician borrowers are eligible
to defer repayment of their federal student loans during their residency
training programs. However, under current law, this deferment is
available for only three years. We support extending the deferment
for qualified borrowers throughout the entire length of a resident physician’s
training period, including fellowships required for sub-specialties.
This would make the deferment consistent with the current guidelines regulating
mandatory forbearance for medical residents, and remove one obstacle facing
borrowers who elect to train for lengthy residency training periods.
4.
Require
Lenders to Report Student Loan Payments to All Credit Bureaus
Current
law requires student loan lenders to enter into agreements with credit
bureaus to exchange information concerning student borrowers. Under
the Department of Education’s regulation 34 CFR
682.208, student loan lenders are required to report information to at
least one of the three major credit-reporting agencies. We believe
lenders should be required by law to report student loan information to
all major credit bureaus. Requiring lenders to report consecutive,
on-time monthly loan repayments would help borrowers establish a strong
credit history.
5.
Mandate
Lenders’ Full Disclosure of Consolidated Loan Terms
Assuring
that consolidation-loan lenders provide notice to loan applicants regarding
various terms of a consolidated loan would assist borrowers in making
informed financial decisions.
6.
Include
Dependent Care Costs in the Definition of “Cost of Attendance”
Currently,
graduate school students are not allowed to include dependent care costs
(health insurance, living expenses, etc.) in the calculation of “cost
of attendance” for loan eligibility. The AMA believes that
the “cost of attendance” definition for medical education
should be changed to include such dependent costs. If this change
were to occur, then these costs would be recognized as part of the students’
budgets and educational expenses when determining graduate medical education
financial aid. In addition, this change would help such students
with the cost of attending medical schools.
7.
Require
Department of Education Study on Medical Student Indebtedness
Many
student loan borrowers enter the workforce with substantial debt.
In fact, physicians enter their residency programs with an average student
debt of $130,500. The high debt burden that many medical graduates
incur often influences their career choices. Medical school graduates
with high loan debt are often deterred from entering public health service,
practicing medicine in underserved areas, starting a career in medical
education or research, or practicing primary care medicine. Conducting
a study on medical student indebtedness would highlight the scope of the
problem and assist in offering effective solutions.
8.
Require
a GAO Study on Residency Programs Lasting More Five Years
Designing
a study to evaluate and determine the reasons for the decline in the number
of medical school graduates pursuing post-graduate studies requiring more
than five years of training would help policymakers better understand
how the high debt burden facing America’s medical student graduates
influences their career choices – and the impact this can have on
patient access to care.
Return
to the Top
First
Higher Education Extension Act of 2007
On
Wednesday, June 6th, the House passed H.R. 2559, the “Higher
Education Extension Act,” by a voice vote. This legislation, which
was sponsored by Rep. George Miller (D-CA), Chairman of the Committee
on Education and Labor, extends the authorization for the Higher Education
Act (HEA) programs through October 31, 2007. The HEA is currently set
to expire on June 30, 2007. The Senate will likely pass this bill shortly.
The HEA has not been reauthorized since 1998. The AMA has submitted its
recommendations on HEA to the House Committee on Education and Labor and
to the Senate Committee on Health, Education, Labor and Pensions.
AMA
Position: The AMA supports several proposals to alleviate
the high student loan debt including expanding the definition of economic
hardship for loan deferment, and expanding the loan deferment period throughout
the residency and fellowship training periods.
Return
to the Top
College
Affordability and Accountability Act
Representative
John Tierney (D-MA) introduced legislation by the same name back in 2004.
It is largely unchanged. According to a press release from 2003, Rep.
Tierney said that the College Affordability and Accountability Act would:
- Increase
States’ Commitment to Affordable College Education: As a condition
of continuing to receive certain federal education funds, States would
have to maintain their own level of college financing to ensure that
they fulfill their end of the bargain to make a quality college education
affordable to all students and stop tuition hikes. States would not
be allowed to continue to cut funding for higher education.
- Curb
College Costs:
All colleges and universities would be required to implement and report
on cost containment strategies as a means to keep tuition prices low.
In addition, the Act commissions a national campaign to identify and
implement best practices to stop rising tuition.
- Provide
Incentives to Control Rising Tuition: The Act would provide additional
mandatory Pell Grant funds, or “Pell Plus Grants,” to schools
that keep their annual net tuition increases at a rate equal to, or
below, the Higher Education Price Index (HEPI). In addition, schools
that guarantee low tuition rates to incoming classes of students through
their graduation would receive additional Pell Plus student aid.
- Put
Students and Families in Control: Students and their families would
have access to accurate information about the cost of college and steps
individual schools are taking to control tuition hikes. Colleges and
universities would be required to make their tuition prices, room and
board, and other related expenses easily accessible to the public, through
their websites, college applications and in other print materials. The
Act would establish a national online college price calculator, to allow
students and parents to figure out the price of a particular college.
Return
to the Top
Collection
of Articles on the HEA
Sharing
the Pain: http://insidehighered.com/layout/set/print/news/2005/07/22/hea
More
Money All Around: http://insidehighered.com/layout/set/print/news/2007/06/08/approps
An
Ambitious Student Aid Bill: http://insidehighered.com/layout/set/print/news/2007/06/13/loans
Competition
to Aid Students: http://insidehighered.com/layout/set/print/news/2007/06/14/house
Senate
Higher Ed Bill Emerges: http://insidehighered.com/layout/set/print/news/2007/06/19/hea
A
‘Systemic’ Scandal: http://insidehighered.com/layout/set/print/news/2007/06/15/loans
Interpreting
the Sunshine Act: http://insidehighered.com/layout/set/print/news/2007/06/18/agb
Return
to the Top
Student
Loan Sunshine Act
The
House May 9 overwhelmingly passed (414-3) the "Student Loan Sunshine Act"
(H.R.890)
to establish conflict of interest requirements for lenders and institutions
of higher education. The bill is a compromise between Rep. Buck McKeon's
(R-CA) "Financial Aid Accountability and Transparency Act of 2007" (H.R.1994)
and the Democratic version of the "Student Loan Sunshine Act," introduced
Feb. 7 by House Education and Labor Chair George Miller (D-CA).
Among
other provisions, the Sunshine Act would:
- Require
institutions to develop and administer a code of conduct for their financial
aid offices;
- Require
institutions to disclose all relationships with lenders;
- Ban
all gifts, opportunity pools, and revenue-sharing between lenders and
institutions;
- Prohibit
financial aid administrators' participation on lender advisory boards
(other college officials may participate without compensation or reimbursement
of expenses);
- Require
“preferred lender lists” to include at least 3 unaffiliated
lenders and the process that was used to develop the list; and
- Prohibit
staffing of campus financial aid offices by lenders or their employees,
excluding services provided in exit interviews for borrowers.
Senate
Health, Education, Labor, and Pensions Chair Edward Kennedy (D-Mass.)
Feb. 1 introduced his version of the "Student Loan Sunshine Act" (S.
486). Sen. Kennedy plans to address this issue as part of the broader
Higher Education Act reauthorization.
Full
article at AAMC’s Washington Highlights
Per
the CRS Summary on Thomas.gov:
5/9/2007--Passed
House amended.
Student
Loan Sunshine Act
(Sec.
2) Amends title I of the Higher Education Act of 1965 to create a new
part E (Lender and Institution Requirements Relating to Educational Loans).
Requires each lender entering into a preferred lender arrangement with
a covered institution (schools that provide postsecondary studies and
receive federal funds) to:
(1)
certify annually to the Secretary of Education that all of the preferred
lender arrangements in which it participates are in compliance with the
requirements of this Act;
(2)
inform borrowers of their loan options under title IV (Student Assistance),
including information on more favorable loans under such title, before
extending private educational loans for attendance at such institution;
and
(3)
be barred by such school from marketing such loans in a manner implying
the institution's endorsement.
Directs
the Secretary to report to specified congressional committees on the adequacy
of educational loan information provided to borrowers. Requires such report
to include a model disclosure form developed and prescribed by the Secretary
for lender use in providing annual loan information to the Secretary and
covered institutions with which they have a preferred lender arrangement.
Requires such lenders to disclose, in addition to specified loan information,
any philanthropic contributions made to such institutions. Requires such
institutions to provide the Secretary, prospective borrowers, and the
public with the disclosure form information as well as a detailed explanation
of why such loans are beneficial to borrowers.
Requires
covered institutions to disclose on their websites and in their informational
materials:
(1)
that they cannot limit students to recommended lenders and must process
the loan documents of any eligible lender;
(2)
the information provided on the model disclosure form with regard to recommended
lenders;
(3)
the maximum federal grant and loan aid available; and (4) the cost of
attendance.
Requires
covered institutions that provide prospective borrowers with private educational
loan information to: (1) include information on their title IV assistance
eligibility; and (2) compare and distinguish private loans from title
IV loans.
Requires
institutions of higher education (IHEs) to develop, publicize, and enforce
codes of conduct for their officers, employees, and agents prohibiting
actual or apparent conflicts of interest with their financial aid duties,
including, at a minimum, compliance with the following requirements of
this section. Prohibits an institution's officers, employees and agents
that have financial aid duties from accepting certain financial benefits
or fees from, or participating on the advisory councils of, student loan
providers or their affiliates.
Bars
lenders, guarantors, or servicers of educational loans from offering gifts
to officers, employees, or agents of covered institutions. Directs the
Inspector General of the Department of Education to investigate and report
annually to Congress on gift ban violations.
Bans
IHEs from:
(1)
entering into educational loan arrangements that involve lender payments
for recommended lender status;
(2)
requesting or accepting lender assistance with call center or financial
aid office staffing; or
(3)
requesting, accepting, or considering any lender's offer of funds for
private educational student loans in exchange for concessions or promises.
Conditions
the receipt of federal funds and assistance by schools and lenders on
their compliance with part E. Establishes penalties for noncompliant schools
and lenders, including: (1) a ban from
